- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.62 / $2,618.00 / $4,410.00
| Facility | | $260.62 | $2,618.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.53 / $344.16 / $560.53
| Professional | | $241.53 | $344.16 | $560.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.00 / $2,000.00 / $5,454.00
| Facility | | $525.00 | $2,000.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.39 / $702.74 / $3,092.48
| Professional | | $333.39 | $702.74 | $3,092.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.75 / $408.31 / $728.28
| Facility | | $317.75 | $408.31 | $728.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.87 / $521.08 / $1,620.25
| Professional | | $241.87 | $521.08 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.70 / $648.02 / $748.00
| Facility | | $514.70 | $648.02 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.08 / $567.91 / $1,180.28
| Professional | | $311.08 | $567.91 | $1,180.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.47 / $579.38 / $6,679.00
| Facility | | $272.47 | $579.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.93 / $645.11 / $924.27
| Professional | | $497.93 | $645.11 | $924.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.08 / $730.35 / $1,171.27
| Professional | | $389.08 | $730.35 | $1,171.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,000.00 / $5,454.00
| Facility | | $1,061.00 | $2,000.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.09 / $1,018.25 / $3,092.48
| Professional | | $424.09 | $1,018.25 | $3,092.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.27 / $593.54 / $1,422.06
| Professional | | $390.27 | $593.54 | $1,422.06 |